Form K-40h - Kansas Homestead Claim - 2001 Page 2
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Providing the information in this section may speed up the processing of your claim.
(This income should not be included on line 10, page 1.)
Enter, in the spaces provided, the annual amount of all other income not included as household income on page 1, line 10.
Personal and
Settlements (lump
Food Stamps
$
$
$
Student Loans
sum)
Social Security
Nongovernmental
Child Support
$ $
$
$
Gifts
Disability
Source
Amount
Other (See instructions on page 17)
$
I, ________________________________ resided at __________________________________________ during 2001 and have paid or will pay 100%
(property address description)
of the taxes. There are no delinquent taxes due.
If the property listed above was owned by someone other than you or you and your spouse, did that person reside with you in 2001, and/or pay part of
the taxes?
Yes
No
Explain:
What, if any, portion of the homestead property was rented or used for business in 2001? ________%
(See instructions on page 18.)
Complete the information below for ALL persons (including yourself) who resided in your household at any time during 2001. Indicate the number of
months they lived with you and whether or not their income is included on lines 4 through 9 of Form K-40H.
Income
Number of
included on
Date of birth
months resided
Social Security Number
Name
Relationship
lines 4-9,
-
- -
in household
Yes/No
Claimant:
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Page 8
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